A new wave of casino liberalisation is sweeping Australia. The Queensland state government has announced that it is seeking expressions of interest for a casino development in Brisbane, and that it is considering offering two further licenses.

This move was foreshadowed in May last year, when it was announced that the government’s “master plan” for Brisbane might include another casino, after years of lobbying for casino expansion by Echo Entertainment and James Packer.

But with recent research suggesting that poker machines in casinos are more dangerous than those in clubs or hotels, there is good reason to worry that the expansion of existing casinos and the development of new ones will only increase the harm gambling does to the Australian community.

The idea of a second casino on the Gold Coast has also been advocated by the area’s mayor for some time, with the Queensland state government giving qualified approval. A recent proposal for a new casino in Cairns has been granted a streamlined approvals process.

This news out of Brisbane comes days after SkyCity and the South Australian state government finalised a deal to increase the size of the Adelaide casino, with 505 more pokies, 95 additional table games and 300 new automated gaming table terminals.

Just three months ago, the NSW state government approved James Packer’s unsolicited proposal to develop a new casino in Sydney. The rapid expansion of casino venues comes after a less visible growth in casino sizes, with the number of pokies and table games within Australian casinos rising by 14% and 39% respectively between 1999 and 2009.

Governments are keen to tout anticipated benefits to tourism provided by so-called “six star hotels”, and try to downplay the potential harms arising from gambling. Indeed, it seems that “casino” has become something of a dirty word in state government circles. NSW premier Barry O’Farrell insisted on calling the proposed Barangaroo casino a “VIP gaming facility”, while the Queensland government speaks about “integrated developments”.

This spin provides a clue to the underlying economic reality: casinos can promote local economic development only to the extent that they bring in new tourist dollars. When locals spend money at casinos, it drains income from other businesses, or syphons household savings into the pockets of multinational corporations and billionaires like James Packer.

It is unsurprising, therefore, that both the casino proponents and the governments that license them are keen to emphasise that they are targeting international high-rollers. In South Australia, for example, deputy premier John Rau claimed that the redevelopment would attract gamblers who could afford to lose “tens of thousands of dollars in an evening”.

But it is not only the super-rich who will be losing those “tens of thousands in an evening”. Entry to a VIP room isn’t required to lose big. In the pokie halls, machines are designed so that gamblers can lose A$1200 an hour. In NSW, pokies can even be loaded $10,000 at a time.

Given the impending proliferation of new casinos, it is timely to remember that the casino industry – and the profitability of Packer’s Crown Limited, and Echo Entertainment – is underwritten by locals who lose more than they can afford. In 2009-10, casino visitors lost over $3.5 billion in Australia.

Casino mogul James Packer is set to build Sydney’s second casino at Barangaroo. AAP/Dean Lewins
Most gamblers are locals, with international visitors making up just 5% of customers at Australian casinos. Most casino revenue does also not come from VIPs, who in 2007-08 contributed only 17% of casino gambling revenue. Instead, 40% of casino gambling profits came from pokie players, with the remaining 43% being lost in the main gaming table halls.

Given that an estimated 41% of pokie expenditure comes from problem gamblers – as does between 12% and 32% of casino table game expenditure – between 20% and 30% of gambling revenue at Australia casinos may be derived from problem gamblers. This, however, is under the doubtful assumption that no VIP gamblers are experiencing gambling problems. Casinos, therefore, are unlikely to be viable in their current form without causing serious harm to their best patrons.

Some acknowledgement of this is implicit in the agreement between the South Australian government and SkyCity. The agreement includes so-called “responsible gambling” measures such as voluntary pre-commitment and funding for the rehabilitation services for problem gamblers. As evidence suggests that voluntary pre-commitment is unlikely to substantially reduce levels of gambling harm, the funding for rehabilitation can only be understood as a partial attempt to rebuild the lives that an expanded casino will play a crucial role in shattering.

Might it not be better to reduce the harm caused by casinos in the first place? Such an approach, which seeks to prevent gambling-related harm, has been likened to placing a fence at the top of a cliff, rather than placing an ambulance at the bottom.

However, with new casinos proliferating and harm minimisation proposals such as mandatory pre-commitment A$1 maximum bets defeated – in part due to the casino lobby itself – it seems that the odds of an evidence-based approach to casino regulation in Australia remain long.

Casino gaming is on the rise across much of the developed world, with governments increasingly unable to resist the allure of windfall taxes and a hefty influx of cash for the local economy. Massachusetts embraced the trend in 2011 when the state legislature voted to legalise casinos. Construction is underway for the state’s first casino at Plainridge Park, with 1,250 slot machines, harness racing and an estimated 500 new jobs.

That decision is now up for review, with a repeal referendum to be considered in the November midterms. In deciding whether to support the repeal, Massachusetts voters will need unbiased information about the social impact of gambling and its downsides. Sadly it’s going to be much harder to come by than you might think.

A compromised research agenda
Anyone looking for good quality evidence about the consequences of gambling first needs to understand how knowledge about gambling is produced. How do we know what we know? Who dictates the research agenda? How is research funded? How do we ensure that we have a sound base of impartial knowledge on which to build policy?

The answers to these questions are profoundly depressing. While in the fields of tobacco and alcohol research, academics regularly debate conflicts of interest and interrogate the strategic use of research and evidence, many gambling researchers remain dependent on industry funding. Gambling is an area largely devoid of disclosure policies, and many researchers are unreflective or outright defiant about industry influence.

Researchers, regulators and policy makers champion a “partnership model” for producing research, not so much “business as usual” as “we are all in this together.” This remarkable state of affairs contrasts markedly with other fields and produces a weak knowledge base that is unevenly influenced by industry interests.

The impact on the discipline is striking. A large proportion of spending goes on prevalence studies – counting problem gamblers in the general population. These surveys are popular with industry because they make it possible to downplay the absolute numbers of pathological gamblers, along with the percentage of the general population at risk from gambling problems, the percentage of gamblers who experience problems and the proportion of profits that come from problem gamblers (estimated at between 30 and 50%).

Prevalence studies also tend to sidestep the question of social class, thus disguising the inconvenient fact that most of the harm from gambling occurs in disadvantaged populations – those with the least capacity to absorb it.

The problem with problem gamblers
Complementing prevalence studies is a vast body of research on problem gamblers. Much of it rests on the assumption that gambling is a harmless leisure activity which makes a net contribution to public funds through either taxation or out of town tourism.

The idea that normal consumers gamble without ill-effect creates a separate category of defective consumers labelled as “problem gamblers”. According to this framework, solutions to problems with gambling are to be sought on an individual level. The alternative approach – to see gambling as an aspect of public health that may be managed by limiting the supply of particular products – is poorly supported by industry or government funding, particularly where taxes on the profits of gambling have become an important source of state income, as in Australia, Canada and, increasingly, the United States.

A minority of critical researchers continue to agitate for change – arguing that research should not be funded by the industry, that priorities should not be set by industry-influenced panels, and that research should have a public health remit.

The role of researchers
So far, these arguments have fallen on deaf ears. Senior researchers are not only content to take industry money, they are also prepared to defend these arrangements.

In December 2000 Nottingham University decided to accept a donation from British American Tobacco of £3.8 million to establish an International Centre for Corporate Responsibility. The executive editors of leading respiratory medicine journal Thorax, John Briton and Alan Knox, wrote an open letter arguing that “accepting money from the tobacco industry degrades the reputation of our University and undermines the work of all with a commitment to the teaching of medicine and the promotion of public health.”

Professor Richard Smith, editor of the British Medical Journal, resigned from his post at Nottingham, followed by a team of 20 cancer researchers, led by Professor David Thurston.

Almost 14 years later, Professor Alex Blaszczynski, editor-in-chief of the journal International Gambling Studies, and one of the most prominent gambling scholars in the world, received $1.2 million from the New South Wales clubs industry to study problem gambling in Australia. Australians have the highest gambling losses per resident adult of any country in the world and spend more on gambling than they do on alcohol or petrol.

Asked to defend this arrangement, Blaszczynski said:

Because of the nature of gambling, you do have to start looking at gaining access to data held by the industry, by patrons who are in industry venues and start looking at real life research that provides sensible, evidence-based information.

Blaszczynski’s defence is disappointing. It does not engage with the most pressing criticism: scholars in the fields of alcohol and tobacco have shown that industry funding systematically influences findings.

Further, by accepting that industry can control such access, Blaszczynski is, in effect, arguing for a monopoly on knowledge production for those who get along with the industry.

How industry funding frames the agenda
Blaszczynski’s acceptance of industry funding is not, however, exceptional and many in the field of gambling studies in the US, where funding for research is one-twentieth that of Australia and Canada, would vigorously defend his actions.

US universities enter into partnerships with individual casino companies. US academics compete for funding from the National Centre for Responsible Gaming (NCRG) which is paid for by the American Gaming Association and claims to have mandated, “stringent firewalls to separate the gaming industry’s contributions from the research it funds”. The effectiveness of these firewalls, and similar mechanisms in the UK and Australia, is debatable.

Not surprisingly, the National Centre for Responsible Gaming focuses exclusively on the disease model of gambling addiction and does not fund research with a wider social purview. Senior research director Christine Reilly recently justified this approach by saying:

To me it seems kind of silly to spend time and money on an issue that is extremely difficult to research, because you can’t count on people’s memory.“

John Warren Kindt, Professor of Business and Administration at the University of Illinois recently described NCRG output as “research designed not to hurt the gambling industry and to misdirect the debate”.

The trust deficit
Some research with a broader public health remit can be found in Australia and the US, but, as I discovered when I interviewed researchers for my study of gambling research, it is likely to be criticised and ignored. The price of independence is the loss of funding and access to data.

We depend on researchers and public health organisations to inform us about the potential harms associated with gambling, consuming alcohol or smoking. The purpose of this research is to better understand how risky activities affect communities and help us to judge what restrictions, if any, should be placed on their supply and promotion.

We cannot trust gambling research. We must therefore be sceptics. Every expert invited to give evidence to a committee on gambling should be asked, “Have you ever accepted money from the industry to conduct a piece of research, write a paper or attend a conference?”

In the absence of a culture of disclosing interests, every paper submitted as evidence should be contextualised – again we must ask “Who paid for this research?” and “How did this person gain access to data?”

It’s not much – it doesn’t produce the independent research that we so urgently need – but until the field of gambling research undergoes meaningful reform it’s the least we need to do.

In the meantime, voters such as those in Massachusetts looking for independent research, will have little choice but to roll the dice.

The UK government is mulling a review of the regulations on fixed odds betting terminals commonly found in pubs and betting shops, in order to reduce the risk of problem gambling developing.

Based on a report from the UK Department for Digital, Culture, Media and Sport, this would see the maximum stake gamblers can bet on the machines reduced from £300 a minute to between £2 and £50.

Given that the Gambling Commission, the industry regulator, found 43% of people who use the machines are either problem or at-risk gamblers, some such as opposition Labour MP Tom Watson, have described this as “a squandered opportunity”. Critics believe the proposals don’t go far enough to protect people from fixed odds betting terminals, sometimes described as “the crack cocaine of gambling” due to their addictive nature.

Harmful gambling can have crippling financial and social effects on the gambler, their friends and family. In the first national study of the social impact of harmful gambling in Ireland, we examined how it affected recovering gamblers, their families and friends. We also heard stories from counsellors and those who provide services to help gamblers. Talking to people from all walks of life, from different age groups and different economic backgrounds, we found that a common theme was the devastating social effects gambling had on people’s lives.

In particular, we learned that gamblers were often exposed to gambling at an early age, for example by collecting betting proceeds for a family member, or watching adults place bets. This then led them to participate in gambling before the legal age of 18.

Gamblers reported gambling in secret, isolating themselves from family and friends to feed their addiction. As relationships deteriorated, the gambler’s behaviour would only be discovered when they were no longer able to maintain a double life, such as failing to intercept unpaid bills that had been part of trying to maintain a facade of normality. The availability of technologies, such as smartphones, means that it’s possible to conceal a secret gambling habit for years, before financial and emotional crises reach breaking point.

For young people, such technology exacerbates the potential harm of gambling. The participants in our studies frequently spoke of their concern for young people and their risk of addiction due to the availability of gambling apps and websites easily accessible from their smartphones. And while there is supposedly agreement not to offer fixed odds betting terminals in Ireland, some gamblers reported that they had got themselves into trouble using them.

Gambling as a public health issue
The social harms that stem from addictive gambling are not only for the gambler. For example, the wives of gamblers in our study reported how they could sense there was a problem, but believed they were struggling with marital issues, rather than the fallout from gambling addiction. Parents and children of gamblers reported that they could no longer trust the gambler, that they could no longer leave money unattended, and that the gambler had become someone they did not recognise or understand.

In Ireland, the legislation around regulating gambling is outdated. The regulations that might mitigate harms for the individual and for society have not been introduced, and – with support from the Irish Research Council and Ireland’s Department of Social Protection and Department of Justice and Equality – our research sought to provide the evidence base to help draw up the necessary social policies.

The government indicated its intention to move forward with legislation in early 2017, and my research and its follow-up study should inform politicians how to address the social harms of gambling – the costs of which the Institute of Public Health in Ireland has estimated to be greater than government revenue from gambling taxes.

Listen to what gamblers say they need
The participants interviewed said there is a need for open discussion about gambling and the risk it can pose to individuals and their families. Gambling addiction carries with it significant social stigma, shame and isolation – talking openly about its effects can change how we approach this issue.

Interviewees suggested a variety of measures government could take, including regulations that would protect the most vulnerable to gambling addiction, and particularly in regulating how technology now enables secretive gambling. They also identified the need for support that would help prevent and address the harmful effects of gambling addiction.

While there are addiction treatment centres around the country which include services to address harmful gambling, there is little help for those affected by a partner’s or family member’s gambling. The RISE Foundation is a notable exception, providing treatment for the families of those affected by a variety of addictions. But it is based in Dublin only, and family members may no longer have the financial resources to access treatment and support there.

There is an urgent need for a unified, transparent approach to tackling gambling’s harms in Ireland – a national strategy that encompasses public and private sector organisations, similar to those that target alcohol and drug addiction. The UK has the Gambling Commission and NHS support and advice; Ireland has nothing comparable.

Despite the lack of progress from government on the issue there have been benefits to this research: uncovering the extent of gambling’s social harms has helped to get people talking about gambling. For example, in September 2017 the European United Left/Nordic Green Left European Parliamentary Group sponsored a one day conference in Dublin to direct the spotlight on the subject and emphasise the need for updated legislation.

Within the Republic, Problem Gambling Ireland recently opened its doors to lobby against the spread of harmful gambling and to provide referral services to those affected by gambling. These may seem like small steps, but it is small steps that lead the charge for change.